Early Use of Corticosteroid May Prolong SARS-CoV-2 Shedding in Non-Intensive Care Unit Patients with COVID-19 Pneumonia: A Multicenter, Single-Blind, Randomized Control Trial

Autor: Xiao Tang, Xin Liang He, Ying Mei Feng, Bing Sun, Rong Hua Jin, Jia Ying Zhang, Jiao Xie, Yang Zhao, Ji Xiang Ni, Yu Lei Li, Jian Chu Zhang, Jian Su, Zhou Ding, Huan-Zhong Shi, Jun Wen Chen, Li Min Liu, Ke Hu, Wen Wang, Xiu Zhi Wu, Ji Xian Zhang
Rok vydání: 2020
Předmět:
Male
Time Factors
CD3 Complex
T-Lymphocytes
CD8-Positive T-Lymphocytes
law.invention
0302 clinical medicine
Randomized controlled trial
law
Interquartile range
T-Lymphocyte Subsets
Clinical endpoint
Corticosteroid
Single-Blind Method
030212 general & internal medicine
Outcome
Coronavirus disease 2019
Virus shedding
Middle Aged
Intensive care unit
Anti-Bacterial Agents
Hospitalization
Killer Cells
Natural
Treatment Outcome
Methylprednisolone
COVID-19 Nucleic Acid Testing
Disease Progression
RNA
Viral
Female
medicine.drug
Pulmonary and Respiratory Medicine
Adult
medicine.medical_specialty
Randomization
medicine.drug_class
Clinical Investigations
Antiviral Agents
03 medical and health sciences
Extracorporeal Membrane Oxygenation
Internal medicine
Early Medical Intervention
Patients' Rooms
medicine
Humans
Lymphocyte Count
Glucocorticoids
Aged
Proportional Hazards Models
business.industry
SARS-CoV-2
Oxygen Inhalation Therapy
COVID-19
Pneumonia
medicine.disease
Respiration
Artificial
COVID-19 Drug Treatment
030228 respiratory system
Pharynx
business
Zdroj: Respiration
ISSN: 1423-0356
Popis: Background: There is still no clinical evidence available to support or to oppose corticosteroid treatment for coronavirus disease 2019 (COVID-19) pneumonia. Objective: To investigate the efficacy and safety of corticosteroid given to the hospitalized patients with COVID-19 pneumonia. Methods: This was a prospective, multicenter, single-blind, randomized control trial. Adult patients with COVID-19 pneumonia who were admitted to the general ward were randomly assigned to either receive methylprednisolone or not for 7 days. The primary end point was the incidence of clinical deterioration 14 days after randomization. Results: We terminated this trial early because the number of patients with COVID-19 pneumonia in all the centers decreased in late March. Finally, a total of 86 COVID-19 patients underwent randomization. There was no difference of the incidence of clinical deterioration between the methylprednisolone group and control group (4.8 vs. 4.8%, p = 1.000). The duration of throat viral RNA detectability in the methylprednisolone group was 11 days (interquartile range, 6–16 days), which was significantly longer than that in the control group (8 days [2–12 days], p = 0.030). There were no significant differences between the 2 groups in other secondary outcomes. Mass cytometry discovered CD3+ T cells, CD8+ T cells, and NK cells in the methylprednisolone group which were significantly lower than those in the control group after randomization (p < 0.05). Conclusions: From this prematurely closed trial, we found that the short-term early use of corticosteroid could suppress the immune cells, which may prolong severe acute respiratory syndrome coronavirus 2 shedding in patients with COVID-19 pneumonia. Trial Registration: ClinicalTrials.gov, NCT04273321.
Databáze: OpenAIRE
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